Objective: to identify the continuance of sleeping difficulty and medication use in a cohort of older Australian women from baseline to 3-year follow-up and to explore the relationship between these factors and health-related quality of life scores, falls and other health care use. Method: a 3-year longitudinal survey of 10,430 Australian women aged 70–75 years at baseline. These women were participants in the Australian Longitudinal Study on Women's Health randomly selected from the Australian Medicare database. Results: a majority of women (63%) endorsed one or more items related to sleeping difficulty at 3-year follow-up: 33% reported one item only, 16% reported two or three items, and 14% reported more than three items; 4,194 (42.4%) reporting ‘waking in the early hours’, 2,592 (26.0%) ‘taking a long time to get to sleep’, 2,078 (21.0%) ‘sleeping badly at night’, 1,072 (10.8%) ‘lying awake most of the night’ and 1,087 (11.0%) ‘worry keeping you awake’. Total scores on the Nottingham Health Profile sleep sub-scale ranged from 0–100 and were skewed to the right. The median score was 12.57. There was a strong statistical association between reporting sleeping difficulty at baseline and at follow-up. A total of 1,532 (15%) women reported use of sleeping medication at follow-up and women were 6.5 times more likely to report use if they also reported any item of sleep difficulty. There was a moderate level of agreement (88%, {kappa}=0.56) between taking sleeping medication within 4 weeks before the baseline survey and within 4 weeks before follow-up. On multivariate analysis, sleeping difficulty at baseline was negatively associated with general health perceptions, emotional role limitations and general mental health sub-scales of the Short-Form-36 Health Survey at follow-up; the use of sleep medication at baseline was negatively associated with physical functioning, bodily pain, vitality, social functioning and general mental health Short-Form-36 sub-scale scores. The use of sleep medication was also significantly associated with falls, accidents, and health care utilisation. Conclusion: sleeping difficulty is a common and persistent complaint among older women and is strongly associated with use of sleeping medications. Both behaviours are negatively associated with health status.